Impact of an Intensive Lifestyle Intervention on Use and Cost of Medical Services Among Overweight and Obese Adults With Type 2 Diabetes: The Action for Health in Diabetes

Espeland, Mark A.; Glick, Henry A.; Bertoni, Alain G.; Brancati, Frederick L.; Bray, George A.; Clark, Jeanne M.; Curtis, Jeffrey M.; Egan, Caitlin; Evans, Mary; Foreyt, John P.; Ghazarian, Siran; Gregg, Edward W.; Hazuda, Helen P.; Hill, James O.; Hire, Don; Horton, Edward S.; Hubbard, Van S.; Jakicic, John M.; Jeffery, Robert W.; Johnson, Karen C.; Kahn, Steven E.; Killean, Tina; Kitabchi, Abbas E.; Knowler, William C.; Kriska, Andrea M.; Lewis, Cora E.; Miller, Marsha; Montez, Maria G.; Murillo, Anne; Nathan, David M.; Nyenwe, Ebenezer; Patricio, Jennifer; Peters, Anne L.; Pi‐Sunyer, Xavier; Pownall, Henry J.; Redmon, J. Bruce; Rushing, Julia; Ryan, Donna H.; Safford, Monika M.; Tsai, Adam Gilden; Wadden, Thomas A.; Wing, Rena R.; Yanovski, Susan Z.; Zhang, Ping

doi:10.2337/dc14-0093

Cited by 151 publications

(156 citation statements)

References 29 publications

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“…This weight loss was significantly greater than the 0.7% and 3.5% weight loss in DSE at year 1 and the end of intervention, respectively. As noted earlier, the lifestyle intervention had a large number of both short‐term and long‐term health benefits relative to DSE 4, 5, 6, 7, 8, 9, 10. In addition, the lifestyle intervention was associated with a reduction in medical care costs, with a 10% savings related to hospitalizations and a 7% savings in medication costs.…”

Section: Discussionmentioning

confidence: 74%

“…In addition, the lifestyle intervention was associated with a reduction in medical care costs, with a 10% savings related to hospitalizations and a 7% savings in medication costs. Over 10 years, the ILI led to a mean relative per person cost saving of $5,280 7. Future work, which will incorporate additional follow‐up, will evaluate the overall cost‐effectiveness of the intervention.…”

Section: Discussionmentioning

confidence: 99%

“…Salary data (including fringe costs) for these efforts were obtained in 2007 dollars (to adopt a common benchmark within the time span of the intervention). For consistency and comparison to a previous Look AHEAD publication 7, salaries were inflation‐adjusted by 3% per year to be in 2012 dollars. Staff salaries associated with participant visits that occurred in 2001/2002 used this 2012 inflation‐adjusted salary, whereas those associated with participant visits in 2003 and beyond not only received the inflation adjustment to 2012 but also received a 3% salary increase for each year beyond 2002.…”

Section: Methodsmentioning

confidence: 99%

“…lifestyle intervention, reduced the risk of developing diabetes by 58% compared with a placebo intervention 3. In Look AHEAD, intensive lifestyle intervention (ILI) did not reduce cardiovascular morbidity and mortality in persons who were overweight or obese with type 2 diabetes 4, but it produced improvements in sleep apnea, incontinence and erectile dysfunction, reduced the incidence of high‐risk kidney disease and resulted in better long‐term diabetes control and some remission of diabetes, as well as fewer hospitalizations, compared with the control group 5, 6, 7, 8, 9, 10. An important concern often raised 11 is that these interventions are costly to provide: data are needed on the costs involved in offering different types of weight loss programmes.…”

Section: Introductionmentioning

confidence: 99%

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Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Rushing

Wing

Wadden

et al. 2017

Obesity Science & Practice

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SummaryObjectiveThe Action for Health in Diabetes (Look AHEAD) trial was a randomized controlled clinical trial to compare the effects of 10 years of intensive lifestyle intervention (ILI) with a control condition of diabetes support and education (DSE) on health outcomes in over 5,000 participants with type 2 diabetes. The ILI had significantly greater weight losses than DSE throughout the trial. The goal of this analysis is to describe the cost of delivering the intervention.MethodsThe ILI was designed to promote weight loss and increase physical activity. It involved a combination of group plus individual intervention sessions, with decreasing frequency of contact over the 10 years. The intervention incorporated a variety of strategies, including meal replacement products, to improve weight loss outcomes. The costs of intervention delivery were derived from staff surveys of effort and from records of intervention materials from the 16 US academic clinical trial sites. Costs were calculated from the payer perspective and presented in 2012 dollars.ResultsDuring the first year, when intervention delivery was most intensive, the annual cost of intervention delivery, averaged (standard deviation) across clinical sites, was $2,864.6 ($513.3) per ILI participant compared with $202.4 ($76.6) per DSE participant. As intervention intensity declined, costs decreased, such that from years 5 to 9 of the trial, the annual cost of intervention was $1,119.8 ($227.7) per ILI participant and $102.9 ($33.0) per DSE participant. Staffing accounted for the majority of costs throughout the trial, with meal replacements and materials to promote adherence accounting for smaller shares.ConclusionsThe sustained weight losses produced by the Look AHEAD intervention were supported by intervention costs that were within the range of other weight loss programmes. Future work will include an evaluation of the cost‐effectiveness of the ILI and will contain additional follow‐up data.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Rushing

Wing

Wadden

et al. 2017

Obesity Science & Practice

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“…Many studies have found that current MRFs are important drivers of future morbidity and mortality among individuals with established CVD in a dose‐response fashion 26, 27, 28. Although studies within and outside the United States have attempted to estimate the incremental healthcare expenditures associated with individual cardiovascular MRFs among those without established CVD,29, 30 no study has detailed the potential economic impact of CVD MRFs on pharmaceutical costs, which remains one of the largest contributors to overall healthcare expenditures.…”

Section: Discussionmentioning

confidence: 99%

Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012–2013 Medical Expenditures Panel Survey

Salami

Ogunmoroti

Spatz

et al. 2017

JAHA

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BackgroundAtherosclerotic cardiovascular disease (ASCVD) causes most deaths in the United States and accounts for the highest healthcare spending. The association between the modifiable risk factors (MRFs) of ASCVD and pharmaceutical expenditures are largely unknown.Methods and ResultsWe examined the association between MRFs and pharmaceutical expenditures among adults with ASCVD using the 2012 and 2013 Medical Expenditure Panel Survey. A 2‐part model was used while accounting for the survey's complex design to obtain nationally representative results. All costs were adjusted to 2013 US dollars using the gross domestic product deflator. The annual total pharmaceutical expenditure among those with ASCVD was $71.6 billion, 33% of which was for medications for cardiovascular disease and 14% medications for diabetes mellitus. The adjusted relationship between MRFs and pharmaceutical expenditures showed significant marginal increase in average annual pharmaceutical expenditure associated with inadequate physical activity ($519 [95% confidence interval (CI), $12–918; P=0.011]), dyslipidemia ($631 [95% CI, $168–1094; P=0.008]), hypertension: ($1078 [95% CI, $697–1460; P<0.001)], and diabetes mellitus ($2006 [95% CI, $1470–2542]). Compared with those with optimal MRFs (0–1), those with average MRFs (2–3) spent an average of $1184 (95% CI, $805–1564; P<0.001) more on medications, and those with poor MRFs (≥4) spent $2823 (95% CI, $2338–3307; P<0.001) more.ConclusionsWorsening MRFs were proportionally associated with higher annual pharmaceutical expenditures among patients with established ASCVD regardless of non‐ASCVD comorbidity. In‐depth studies of the roles played by other factors in this association can help reduce medication‐related expenditures among ASCVD patients.

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Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes

Johansen

MacDonald

Hansen

et al. 2017

JAMA

181

159

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IMPORTANCEIt is unclear whether a lifestyle intervention can maintain glycemic control in patients with type 2 diabetes. OBJECTIVE To test whether an intensive lifestyle intervention results in equivalent glycemic control compared with standard care and, secondarily, leads to a reduction in glucose-lowering medication in participants with type 2 diabetes. DESIGN, SETTING, AND PARTICIPANTS Randomized, assessor-blinded, single-center study within Region Zealand and the Capital Region of Denmark (April 2015-August 2016). Ninety-eight adult participants with non-insulin-dependent type 2 diabetes who were diagnosed for less than 10 years were included. Participants were randomly assigned (2:1; stratified by sex) to the lifestyle group (n = 64) or the standard care group (n = 34).INTERVENTIONS All participants received standard care with individual counseling and standardized, blinded, target-driven medical therapy. Additionally, the lifestyle intervention included 5 to 6 weekly aerobic training sessions (duration 30-60 minutes), of which 2 to 3 sessions were combined with resistance training. The lifestyle participants received dietary plans aiming for a body mass index of 25 or less. Participants were followed up for 12 months.MAIN OUTCOMES AND MEASURES Primary outcome was change in hemoglobin A 1c (HbA 1c ) from baseline to 12-month follow-up, and equivalence was prespecified by a CI margin of ±0.4% based on the intention-to-treat population. Superiority analysis was performed on the secondary outcome reductions in glucose-lowering medication. RESULTS Among 98 randomized participants (mean age, 54.6 years [SD, 8.9]; women, 47 [48%]; mean baseline HbA 1c , 6.7%), 93 participants completed the trial. From baseline to 12-month follow-up, the mean HbA 1c level changed from 6.65% to 6.34% in the lifestyle group and from 6.74% to 6.66% in the standard care group (mean between-group difference in change of −0.26% [95% CI, −0.52% to −0.01%]), not meeting the criteria for equivalence (P = .15). Reduction in glucose-lowering medications occurred in 47 participants (73.5%) in the lifestyle group and 9 participants (26.4%) in the standard care group (difference, 47.1 percentage points [95% CI, 28.6-65.3]). There were 32 adverse events (most commonly musculoskeletal pain or discomfort and mild hypoglycemia) in the lifestyle group and 5 in the standard care group.CONCLUSIONS AND RELEVANCE Among adults with type 2 diabetes diagnosed for less than 10 years, a lifestyle intervention compared with standard care resulted in a change in glycemic control that did not reach the criterion for equivalence, but was in a direction consistent with benefit. Further research is needed to assess superiority, as well as generalizability and durability of findings.

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Impact of an Intensive Lifestyle Intervention on Use and Cost of Medical Services Among Overweight and Obese Adults With Type 2 Diabetes: The Action for Health in Diabetes

Cited by 151 publications

References 29 publications

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Cost of intervention delivery in a lifestyle weight loss trial in type 2 diabetes: results from the Look AHEAD clinical trial

Association Between Modifiable Risk Factors and Pharmaceutical Expenditures Among Adults With Atherosclerotic Cardiovascular Disease in the United States: 2012–2013 Medical Expenditures Panel Survey

Effect of an Intensive Lifestyle Intervention on Glycemic Control in Patients With Type 2 Diabetes

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